Patient Handoffs

Resources for Improving Patient Handoffs

In 2006, the Joint Commission added transitions in patient care to its national Patient Safety Goals, referencing the need for "a standardized approach to hand-off communications, including an opportunity to ask and respond to questions." This goal is even more essential since limits on duty hours have also increased the use of "cross coverage," defined as residents outside of the primary care team providing care in the absence of the primary team. Despite the ACGME's requirement that programs ensure that residents are competent in the hand-over process, resident physicians believe transitions are not adequately addressed in education and practice. Many note that processes are haphazard, with no system of organized interaction.

Handoffs should provide timely, accurate information about a patient's care plan, treatment, current condition and any recent or anticipated changes. Handoffs should: 1) be standardized and clearly defined; and 2) involve face-to-face exchange between the caregivers involved. Below are some of the model procedures used by institutions to standardize effective handoffs. Being aware of them can help you remember the most important information to communicate during a handoff.

S: Situation - Communicate the current status and circumstances, including code status, level of certainty or uncertainty, recent changes and response to treatment

S: Safety Concerns - What are the critical lab values and reports? Any socioeconomic factors to be aware of? Any allergies or alerts (ex: risk for falls)?

The

B: Background - Identify comorbidities, previous episodes, current medications and family history. Verify the patient's insurance. Is the family available for support? Are there any advance directives?

A: Actions - Detail what actions were taken or are required and provide a brief rationale for those actions

T: Timing - What is the level of urgency? Include explicit timing and prioritization of actions.

O: Ownership - Who is responsible (nurse/doctor/team), including patient and family responsibilities?

N: Next - What is the plan of action? Are there any time critical actions needed? Any anticipated changes? Are there any contingency plans?

Includes no superfluous data categories, easy to identify problems, and if/then and to-do statements

Error-prone medications clear and correct?

All medications should be listed clearly and all antibiotics with start dates

Directions clear and concise?

Educational Videos

The Do's & Don'ts of Patient Handoffs - Hospitalists may be tempted to rely on their electronic health record systems to do all the work on patient handoffs, but that probably won't turn out very well. Instead, Dr. Vineet Arora offers three strategies to improve patient handoffs.